How does dental Insurance work?  Dental benefits aren’t really insurance plans because they don’t provide coverage for a catastrophic loss.  Your dental benefit plan is an agreement to help pay for some of your dental needs.  The more your employer(or you) pays for coverage, the lower your out-of-pocket costs will be.

I am looking for a Columbus dentist that is on my dental plan?  This may surprise you but a large percentage of Columbus dentists aren’t on any dental insurance provider lists.  Many dental insurance plans allow you to go to any dentist.  The dental insurance will pay a portion of your dental bill and the remainder will be the patient responsibility.  But when you look at how much  you are paying for dental insurance(typically about 5% of what you pay each month for your medical insurance) you understand why it doesn’t cover as much.  If you want to have a wide choice of Columbus dentists to choose from, be sure to pick a dental insurance plan that allows you to choose any dentist. 

How are dental plans different? Most dental plans have deductibles, maximums of the amount of $$$ they will pay per plan year, and which dental services they exclude.  Of all the dental procedures a dentist does, over half of them are excluded from most dental insurance contracts.  

My dental plan covers 100%. Perhaps for some services it does but it’s 100% of what?  Many plans say they cover 100% of a filling fee but it’s not 100% of the fee the dentist charges for the filling but 100% of the fee set in the insurance companies fee schedule. 

Can you waive my patient portion and accept whatever my dental insurance pays?  This seems innocent and we would like to help, however such things are considered falsified billing.

I reached the maximum of what my dental insurance will pay quickly, is that normal?  The $1000 maximum was set 40 years ago.  At that time, $1000 was considered a reasonable level of dental coverage each year.  Adjusting for inflation, your maximum should be about $5000 today, but employers have sought to keep costs down so the plans stick with the out of date maximum.

Columbus Dentist answers you dental insurance questions:

Dental insurance isn’t really insurance (a payment to cover the cost of a catastrophic loss) at all.  It is actually a money benefit, typically provided by an employer; to help employees pay for routine dental care.  The employer usually buys a plan from an insurance company based on the amount of the money benefit and how much the premium costs per month. And the premium for dental coverage is a fraction of the cost of the premium for medical coverage and with all things in life, you get what you pay for.  And as you know,  there are many Columbus based businesses that invest in decent dental benefit plans for their employees and others that tend to skimp there.

The majority of dental benefit plans are only designed to cover a portion of the total cost of a person’s necessary dental needs.  For example, a dentist may recommend a crown for a tooth that has extensive decay, however, the dental plan may only cover the cost of a filling.  This does not mean that the patient does not need a crown, only that the benefit is limited to a filling.

While a twice yearly insurance payment toward the cost of teeth cleaning is common, that type of payment arrangement actually has no relationship to what any patient might really need. It’s just how their dental benefits plan was setup.

Many patients need cleanings more frequently.  People who have heavy plaque, lots of calculus buildup, or gum disease are prime candidates.  Also, people who are generally healthy but have certain types of systemic conditions, such as diabetes, or those taking specific medications, may require more frequent cleanings.

The good news is that with the help of your dental benefits, the amount you have to pay is reduced!  If you are looking for a new Columbus dentist, give Beth a call at 614-486-7378 and she can answer all your questions.  Or request an appointment online.

 It is exciting when you get that dental insurance benefit-you just know that now you can get that smile you have always wanted.

Dental insurance may have been one reason you chose one job over another. It is a job perk that some receive as an addendum to their medical insurance or a separate negotiated benefit. Unfortunately we aren’t always aware of how the insurance plans work.

 I saw a patient this week that was new to our practice and just received new insurance and was under the impression that he had great coverage. When we went over his treatment plan he couldn’t believe that they only covered a very small percentage of his dental work. He had no idea how the plan worked. 

Each plan and it’s coverage varies according to the contracts between the employer and the insurance company. Some tips on getting to know your insurance plan are to know…

• who controls your treatment- you and your dentist or the insurance company? Some plans may require the dentist to use the “least expensive alternative”.
• Ask to what extent does your insurance cover? Some companies limit your plan to what you can have done.
• Ask what your dental plan covers for prevenative, basic and major work? 
• What is your share for these procedures?
• Ask if there are any limitations on your plan?
• Ask if you are free to see any dentist that you choose? Some companies have a list of Dr.’s that you must see or you don’t have any coverage.

 Whether you have dental insurance or not don’t let the insurance dictate the level of care you want. Find a dentist that will treat you like they would their own family. Hopefully this will help anyone that is looking into dental insurance.

Preferred Provider is a term used by the Insurance Industry to make it sound like these doctors/dentist are “better” than others.  Makes it seem that perhaps your Insurance company has graded the dentist in some way to prefer them over all the other dentists in the area.

In reality, a “Preferred Provider” to a dental insurance company is a dentist that has agreed to take reduced fees in order to be on a list.  And remember that no dentist goes on a list to make less money.  It means they need more patients and they will reduce their fees to get them.

So, how do they make up for the reduced fees?  One way is double booking appointments so they can see more patients in the same day and make up for what they are reducing in thier fees.  What does double booking appointments mean to you?  A long wait in the reception area, in the dental chair, and being rushed through your appoinment just to start with.

Dental Insurance is different than Medical Insurance - In many ways, too many to put in the blog post.  But here are the highlights

• 9 out of 10 medical doctors are on an Insurance preferred provider list
• 2 out of 10 dentists are on an Insurance preferred provider list
• Medical Insurance Lifetime maximum coverage per patient can be 1 million dollars
• Dental Insurance Annual maximum coverage per patient ranges from $800 – $1500 per year.  That would be a lot of years before it reached a million.
• Medical Insurance monthly premium fee is hundreds of dollars
• Dental Insurance monthly premium fee is $10 for a family of 4

So when you decide to chose a dentist because your insurance provider has them on a list, think about this:   Did you spend more time chosing where you are going for lunch?

It’s open enrollment time of year……

It’s that time of year again when patients begin asking which plan they should choose during their employers open enrollment period.  So we thought we would define the different flavors of dental benefit plans out there.

There are probably 50 to 100 different dental benefits providers in the Columbus Ohio area.  And within those plans there are even more different flavors of the plans that were negotiated between your employer and the Insurance company.   A Metlife plan at company A isn’t the same plan as the Metlife Plan at company B.

Dental Plans typically fall into these catagories.  If you are having difficulties figuring out your plan choices, fax us(486-2608) a copy of the pages from your benefits handbook.  

PPO Plans

• You are free to choose any dentist 
• If you choose a dentist from a list, the patient is given financial incentives.  How great are the financial incentives?  That’s hard to determine without a defined fee schedule from your plan.  In our office we’ve seen the difference in cost for a cleaning be nothing.  On average the difference is between $5 and $15 per cleaning. 
• Think about this: Does choosing a dentist on the list save me money, or my insurance company money?
• The PPO Plan pays all or part of the dentist’s fee to the extent that it does not exceed the UCR fee for that service.  How insurance companies calculate the UCR fee

DPO or DMOs

• Under these plans you must choose a dentist from a list to receive any benefit.
• If you do not choose a dentist on the list the entire cost of the dental visit will be your responsibility

My plan says I will be covered up to 80% or up to 100% so I’ve got a great plan, right?

Many plans tell their participants that they will be covered “up to 80% or up to 100%” but do not clearly specify the plan UCR fee schedule, allowance, annual maximum or limitations.  The UCR fee schedule is what they will pay 80% of, not the fee your dentist charges.  (See post on how insurance companies calculate the UCR fee) 

By the way, your dental office has no idea what the UCR fee schedule is for your particular plan with your insurance company.   We don’t know for certain what your insurance company will pay until we receive the claim back.  Based on our experience, it is realistic to expect dental insurance to cover about 50% for major restorative services like crowns, large fillings, and root canals. 

The good news is that most dental benefit plans pay the majority of the fee for your dental maintenance such as cleanings and xrays.  And coming in for professional dental cleanings on a regular basis can help us keep small problems from becoming major restorative stuff.

So which should you cho0se if you are a Grandview Dental Care Patient? 

You need to decide what dental plan to choose based on your needs.  If you choose a plan where you are allowed to choose any dentist(typically a PPO) you will receive dental benefits to help you pay for the cost of the dental work you have done.

Cigna, Metlife, Anthem, UHC, etc, as long as you can choose any dentist, you will have a certain level of coverage from the insurance company and a certain level of out-of-pocket depending on your plans fee schedule.  Remember, you get what you pay for.  If you pay $10 per month for dental coverage for your entire family, you are going to have some out-of-pocket expense for your dental care.

What does UCR fee stand for?

Well… the letters in UCR stand for Usual, Customary, and Reasonable.  Almost sounds like the Insurance company is doing extensive surveys of dental fees in your zip code and then taking the average, say 70% – 75%,  fee.  But guess what, that is not what the Insurance company does.

Insurance companies  calculate the UCR in differing ways, but it’s usually between the 50th and 80th percentile of what fees are in a geographical area.  The geographical area is not limited to a certain radius around a certain zip code.  It can include an entire state and includes all the rural, urban, and suburban dentists and we all know that location can effect the price for good and services. 

The UCR fee guide generated by the insurance company is a price they will allow for every dental procedure they cover.  This is not based on what a dentist actually charges, but what the dental insurance wishes to cover for the premium your employer wants to pay. 

And to further complicate things the Insurance company typically only covers 80% of their UCR fee, so dental benefits were meant to have some patient out-of-pocket expense. 

It’s amazing that the UCR fee varies between insurance companies and even between different plans in the same company. 

This is because dental benefits and the associated UCR fee schedule are determine by the negotiations between the insurance company and your employer.  And the better the dental benefits the plan offers the more you and your employer pay in the premiums to the insurance company.  Your employer has likely selected a UCR fee schedule that corresponds to the premium cost they desire.

So the adage… you get what you pay for…. is alive and well with dental insurance.